POLICY REPORTS

Vaccine Confidence: Countering Misinformation & Hesitancy Report 2020

The Working Group on Vaccine Confidence examined how the pandemic reshaped public trust from the spread of misinformation and polarised online discussion to low health literacy and healthcare worker hesitancy. Across seven themes, the Group set out observations, challenges, strategies and a slate of actions to rebuild confidence and equip HCPs as trusted educators.

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5th Life Course
Immunisation Summit
December 2020

Working Group on Vaccine Confidence

Observations, Challenges, Strategies and Actions

Misinformation
Observations
In Times of Uncertainty, the Public Is More Susceptible to Vaccine Misinformation
  • In times of uncertainty, people search for information to help them decide and navigate the crisis. With the internet the first channel for information, people often face contradictory, misleading and confusing information.
  • With their rush to cover news related to the pandemic, the mainstream media are also offering confusing information that increases uncertainty.
  • Even healthcare professionals, traditionally seen as trustworthy sources of information, are not always able to offer advice, often lacking the knowledge and being confused.
Challenges
It Is Difficult for the Public to Absorb and Understand a Lot of Information From Many Different Sources
  • Too much information on complex new scientific issues in a short space of time is difficult for people to absorb and understand.
  • With information being the only answer to misinformation and disinformation, this inability further complicates things.
  • When people begin to think about vaccines, they bring in their pre-existing world views. Some view things from a libertarian freedom perspective, seeing vaccines as an imposition on personal freedom.
  • These groups are in the minority but pose a significant challenge, as their actions can impact those on the margins.
Strategies
We Must Use Simple and Clear Messages That People Understand and That Can't Be Misinterpreted
  • We should work to restore trust in public institutions and "depoliticise" discussions around vaccination.
  • We need to reinforce the role and visibility of non-partisan experts and committees in vaccination debates and decision-making.
  • HCPs must work in partnership with civic and patient associations to ensure the right messages reach the right audiences.
  • We need to see the people behind vaccine development, see the faces of researchers, and understand what motivates them in their work.
Online Vaccine Discussions
Observations
Online Discussions on Vaccines Have Become More Polarised Since COVID
  • Vaccine conversations online have changed during COVID and have become more polarised.
  • Discussions have become more antagonistic, and there has been more misinformation.
  • There has also been a rise in disinformation — information deliberately shared to be disruptive and cause antagonism.
  • Anti-vaccine groups are now overlapping and mixing with anti-mask campaigners or anti-lockdown groups, and absorbing others such as 5G conspiracists.
Challenges
Fighting Against All Could Be a Waste of Time, Effort and Resources
  • It is often hard to dissuade staunch anti-vaccination supporters and advocates.
  • For certain people, you can offer logical and rational information yet make no progress.
  • For certain people, anti-vaccination is considered a revolutionary act.
  • Reacting and interacting with conspiracy theorists is challenging and could cause more harm than good, because it indirectly helps them spread their views.
Strategies
Targeting the Messages to the Correct Audiences Is Vital to Success
  • We must focus our target campaigns by understanding the audiences and targeting the message in the best way possible, depending on each audience.
  • Focus first on helping people on the margin, who can listen to reason and evidence.
  • Scientific information and evidence are useful, but personal story sharing is often more powerful.
  • Avoid engaging in discussions with conspiracy theorists, since they won't change their views and it will help them spread their ideas.
Online Vaccine Discussions
Observations
More People Are Joining the Vaccines Conversations Online
  • The pandemic has provided a new audience interested in vaccines. The new approach of protecting the elderly first is bringing new people to the conversation.
  • When communicating with the public, the use of complex medical terms could be easily misinterpreted and used by the anti-vaccination movement.
  • The public's health literacy is extremely low, and no effort has been made in the past to educate people in understanding basic terms and meanings related to their health and health technology.
Challenges
How Do We Best Communicate with a Public Amid the Use of Complex Medical Terms?
  • The broad use by media and experts of complex terms related to vaccine technology is difficult for the public to understand.
  • New technologies offer ground for suspicion and confusion, especially when they are not clearly explained and understood by the general public.
  • Experts are not trained to publicly speak about and discuss complex medical terms in a language understood by the public, which would minimise the openings for misinterpretation.
Strategies
Increase the Public's Health Literacy to Counter Misinformation and Disinformation
  • Increase the public's health literacy, choosing what is important to translate into a language and message that people can understand.
  • Increase general health literacy starting from the early years. Engage and work with teachers and schools, reaching not only students but also their families.
  • Build a team of voices to put things in perspective and offer clear, easy-to-understand, reliable information on COVID-19 vaccine safety and efficiency.
  • Be prepared to explain and communicate the results of clinical trials as they become publicly available.
Understanding of Vaccines Technology
Observations
Healthcare Workers' Vaccination Uptake and Confidence Is Lagging Behind
  • Recent data shows that vaccination uptake among healthcare professionals is still lagging behind the target.
  • Vaccination of healthcare workers for COVID-19 is not as high as expected, revealing a deeply rooted vaccine hesitancy among healthcare workers.
  • HCPs often choose not to counter misinformation or disinformation when presented with the opportunity to do so.
Challenges
Healthcare Workers Are Not Being Educated to Understand New Vaccine Technologies
  • Most frontline healthcare professionals are not trained to understand the newly introduced technologies in vaccines, such as mRNA vaccines.
  • Inadequate healthcare professional education about vaccines, vaccinations and public health issues is a significant part of overall hesitancy.
Strategies
Train Healthcare Professionals Across All Specialties on Vaccines Technologies
  • Tackle hesitancy among healthcare professionals by addressing the lack of understanding and education on vaccine technology and public health.
  • Spread education on vaccines and public health to all involved, including all medical specialists, pharmacists and nurses.
HCPs' Role as Educators & Advocates
Observations
All Healthcare Professionals Need to Engage and Collaborate as Educators and Advocates
  • Communication on vaccines is often directed top to bottom — from experts and policymakers to the public.
  • We often forget the importance of our grassroots workers, such as private practice physicians, pharmacists and nurses working in local communities. They are the most trustworthy source of advice and providers of information to people.
Challenges
A Current Lack of Education and Collaboration Among Community HCPs
  • Community physicians and pharmacists are not trained in public health and vaccines. A lack of education on new vaccine technology makes it very difficult for them to dispel misconceptions and feel confident to offer credible advice.
  • Gaps exist in collaboration between community pharmacies, hospital pharmacists and physicians.
  • Information spread through media by experts directly to the public has not been explained first to community physicians and pharmacists, who are often the first point of contact people will ask to explain more.
Strategies
HCPs Working Within Communities Need to Become Trusted Sources of Information
  • Train community healthcare professionals (physicians and pharmacists) on public health and vaccines, helping them gain the confidence and knowledge to advise local communities.
  • Establish channels of communication between community HCPs and decision-makers, ensuring they are first informed on developments and announcements they must explain to their communities.
  • Strengthen vaccination delivery systems by building a trained community HCP network that could help administer vaccines, if needed, and answer the public's questions.
Managing the Public's Expectations
Observations
The COVID Vaccines Are Seen by Many as a Silver Bullet That Will Solve All Problems
  • A perception has been built among the public that the COVID-19 vaccine is the silver bullet that will end the pandemic and give them their lives back immediately.
  • For a tired public, it is difficult to understand that even with the new COVID vaccines being rolled out, we will still need to be very careful about social distancing and wearing masks.
  • If the COVID vaccination results do not meet expectations, disappointment could damage public trust for COVID vaccines and all vaccines.
Challenges
Any Problems with COVID Vaccine Production and Rollout Could Test Public Confidence in All Vaccines
  • High expectations from COVID vaccines will help to increase the much-needed uptake, but a balance is needed.
  • Eventually, when COVID infections decrease through broad immunisation and the public no longer sees the disease's impact, willingness to get vaccinated will decrease.
  • Policymakers, pushed by the public's tiredness, often offer a very optimistic perspective on how vaccination will end the pandemic very soon.
Strategies
We Must Be Honest in Terms of Expectations of Vaccines in Returning Life to 'Normal'
  • We must be honest from the outset that even with a successful vaccine rollout, other measures (such as social distancing) will be needed for the foreseeable future.
  • The logistics of each step — 1) availability, 2) distribution, 3) administration and 4) pharmaco-surveillance of COVID vaccines — will be crucial and must be anticipated in all details.
  • The infrastructures put in place for the rollout of the COVID vaccine must be considered a success by the general public.
Communicating with the Elderly
Observations
Elderly People Are Less Vulnerable to Online Misinformation but Still Need Information
  • Elderly people are less susceptible to online misinformation, but it is difficult for them to access vaccine information and understand new vaccine technologies from other sources.
  • Connecting with the elderly on vaccines is even more critical during COVID, as they will be the first group to receive the vaccine.
  • Disabled people and people with chronic diseases are challenging to reach and inform under the current circumstances.
Challenges
Connecting with the Elderly, Disabled and Those with Chronic Conditions
  • Vaccine hesitancy must be viewed through the lens of health equity and access.
  • Elderly people may be less influenced by conspiracy theories (older persons are not active on social media), yet may have more insecurity — fearing the vaccine is an intervention doing more harm than good to an older person with a range of health problems.
  • We have to look at complacency, convenience and confidence as different aspects of hesitancy. Confidence is the opposite of hesitancy, but we can't forget the issues of convenience or access.
Strategies
Engage with Those Who Are in Constant Contact with Elderly People
  • Healthcare professionals have an increased role to play during the pandemic, reaching out to elderly people and people with chronic conditions, providing credible information and advice and making sure they get vaccinated.
  • Healthcare professionals' education is essential when dealing with older persons as trusted points of information, addressing their insecurities and fears.

Vaccine Confidence Suggested Actions and Campaigns 2021/22

  • A "Did You Know" Campaign Directly to the Public — a short YouTube video of 4 minutes, developed alongside HCPs to provide the public with straightforward, easy-to-view and shareable information on established vaccines and new vaccine technology.
  • The Development of Vaccine Infographics and Videos for HCPs to Share — free-to-use materials developed and shared with HCPs to communicate with patients, stating the facts on every aspect of the vaccine development process, trials, production ingredients and more, to alleviate concerns.
  • An HCP-Led Vaccine Education Campaign for Schools — targeting the creation and dissemination of educational materials for teachers and school managers on vaccines and vaccine technology, to arm them to lead informed discussions with concerned parents.
  • Vaccine Talks and Information from HCPs Direct to the Public — short 90-second videos with experts answering the most frequently asked questions, and interviews with the people behind the vaccine's development.
  • Build a Free-to-Access Platform with a Dictionary of Key Vaccines Terms — developed in very simple language as a resource accessible to the public, with links to official information sources such as EMA, ECDC and the national authorities licensing the vaccines.

Vaccine Confidence Suggested Actions and Campaigns 2021/22

  • Development of a Top 10 Vaccines Safety Portal/Podcast — developed for both HCPs and the public, with the top 10 pieces of safety information on vaccines and links to a news section.
  • 2021 Expert Working Group on HCPs and New Vaccine Technology — hosting an expert meeting on how to educate healthcare professionals across all specialties on the different vaccine technologies and their pros and cons.
  • Free-to-View Webinar Course for HCPs and Accompanying Educational Campaign on Vaccine Technology — aimed at explaining the various vaccine technologies and the benefits they would have in each case, helping HCPs advise on different vaccines based on the technology used.
  • Education Program on Vaccine Technology Specifically for Pharmacists — an online education program targeting pharmacists, in collaboration with pharmacy students, to train them to speak to their clients about all their vaccine concerns and advocate vaccines at every visit.
  • Education Campaign Specifically for Nurses — focusing on personal vaccine uptake and providing them with usable, precise information when speaking with patients and the public.

Contributors

Jess McNamara (EPSA) • Daphne Holt (CLCI) • Nenad Miljković (EAHP) • Mihai Craiu • Barbara Rath (ViVI) • Mariano Votta (ACN) • Roy Philip • Catherine Weil-Olivier • Silvia Romeo (Think Young) • Marianne Chagnon (UEMS) • Elizabeth Adams (EFN) • Alison Maaasen (EuroHealthNet) • Maria Viegas (EMSA) • Sam Nye (CoMO) • Daniela Quaggia (ACN) • Gary Finnegan (Vaccines Today) • Irena Bralic